Remote navigation systems in electrophysiology.

Today, atrial fibrillation (AF) is the dominant indication for catheter ablation in big electrophysiologists (EP) centres. AF ablation strategies are complex and technically challenging. Therefore, it would be desirable that technical innovations pursue the goal to improve catheter stability to increase the procedural success and most importantly to increase safety by helping to avoid serious complications. The most promising technical innovation aiming at the aforementioned goals is remote catheter navigation and ablation. To date, two different systems, the NIOBE magnetic navigation system (MNS, Stereotaxis, USA) and the Sensei robotic navigation system (RNS, Hansen Medical, USA), are commercially available. The following review will introduce the basic principles of the systems, will give an insight into the merits and demerits of remote navigation, and will further focus on the initial clinical experience at our centre with focus on pulmonary vein isolation (PVI) procedures.

Control de la lepra por los servicios sanitarios generales - revisión del concepto de integración / Leprosy control through general health services revisiting the concept of integration

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Integración de los servicios sanitarios para la lepra / Integration of leprosy services

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Luta contra as dermatoses com sifnificado medico-social (esboco para a regiao de Campinas) / Fight against the dermatosis with meaning doctor-social

São definidas como "dermatoses com significado médico-social" as doenças que manifestam expressão cutânea e algumas vezes repercussão orgânica grave, podendo determinar, temporária ou permanentemente, incapacidade sócio-profissional, com reflexos morais e econômicos mais ou menos intensos na comunidade. Entre estas dermatoses, destacam-se as parasitárias e infecciosas seguintes: sarcoptose (sarna vulgar), pediculoses, micoses superficiais (tinhas), micoses profundas (tais como a paracoccidioidomicose de lutz e a esporotricose), viroses exantemáticas, a hanseníase e as doenças de transmissão sexual (venéreas), etc. Dando a idéia um sentido mais lato, podem ser incluídas na mesma rubrica as doenças toxicoalérgicas, a úlcera de perna, as dermatoses cancerizáveis, o câncer cutâneo e as doenças de pele de causa profissional. Essas doenças devem ser cuidadas por Unidade de Saúde dinâmica integrada com a Universidade. Descrevem-se a estrutura e o funcionamento de Unidade desse tipo.

Proposals for a pilot project to promot the integration of the hanseniasis patient into society

After a year long study of the Bauru region in the Brazilian state of São Paulo, the autor found 8 basic and interdependent obstacles and comment which hamper the integration of the hanseniasis patient into society. These obstacles: the lack of a central authority to control integration activities in the region; the lack of basic dogmas nad guidelines on which to build a rehabilitation program; the inadequate use of educational resources; the lack of integration of hanseniasis work in the general medical care system; the low quality of basic medical care for the hanseniasis patients; the lack of socio-economic support systems for the hanseniasis patient in his community; the large number of patients in Lauro de Souza Lima interned for non justifiable reasons; the presence of a growing settement of hanseniasis patients on the outskirts of Lauro de Souza Lima; some comments on the structure and function of the pilot project. Each of these obstacles is briefly discussed and suggestions are then given for a coordinated program to overcome them.

New concepts of hospitalization of hanseniasis patients and their proctical application in Sao Paulo, Brazil

Five large specialized "asilo-colônias" were founded in the early thirties in São Paulo with two main objectives - asylum for the physically and/or socially handicapped "lepers", and compulsory isolation for infectious patients. The former degenerated by abuse and institutionalism; the second failed in its purpose of control, and kept the social atmosphere tense. With their resources jammed, these establishments were not able to offer a resonable degree of confort and medico-social assistance to their increasting number of inmates. About 1/3 of the 5000 hanseniasis patients have benn transferred to dispensaries in 1967, and one of the "colonias" was converted into a psychiatric institution. Applications for asylum care are now carefully scrutinized by social workers, and prophylatic isolation is infrequent. Physical rehabilitation, intercurrent illness and scientific research are now the chief reasons for hospitalization, and facilities for such purposes are increasing. the establishments were renamed "Hospitais de Dermatologia Sanitária", after having been dissociated from the extinct "Leprosy Department" and integrated with other public health hospitals. they are frequented by medical students in their curricular activities, and are often the site of dermatological metings and extra-curricular courses. In one of the hospitals, an infirmary is receiving various dermatological cases. The image of the old dreadfull "asilo-colônias" is fading slowly but steadily.